Gastric Cancer

Clinical Description

Gastric (stomach) cancer usually begins in the tissues that line the stomach. Gastric cancer has become far less common over the past 60 years in the United States and Western Europe, however over 21,000 Americans will be diagnosed with the disease this year.

Symptoms of Gastric (Stomach) Cancer

Stomach cancer is most often not recognized until the disease has spread. This is primarily due to the absence of symptoms during the early stages of cancer development in the stomach. When symptoms do become evident, they may be mistaken for other less serious stomach problems such as gas or ulcer disease. Symptoms may include discomfort or pain in the stomach region, bloating, nausea, vomiting, heartburn, weight loss, loss of appetite, or feeling tired.

Risk Factors for Gastric (Stomach) Cancer

Infection with the Helicobacter pylori bacterium, and a diet high in red meat, or smoked and salted foods are among the risk factors for stomach cancer.

The interior lining of the stomach may be evaluated using a thin tube with a camera at the end called an endoscope. Tissue samples may be removed from the stomach during this procedure and examined for cancer cells.

Once the diagnosis is made, it is important to determine if the cancer has spread and, if so, how far. This process is called staging and it is important in guiding what treatment would be most helpful to the patient. Computed tomography (CT) and Positron Emission Tomography (PET) are often used for staging. Endoscopic ultrasound may also be used. Endoscopic ultrasound involves insertion of a special endoscope equipped with an ultrasound probe through the mouth into the stomach. Surgical examination of the abdominal using laparoscopy, a minimally invasive surgical technique, may also be used for staging. During laparoscopy, a thin probe with a camera on its tip is inserted into the abdomen through a small incision, allowing the surgeon to look at the inside of the abdomen and to remove tissue samples to be tested for cancer cells.

Treatment of stomach cancer depends on the stage of disease (the size of the tumor, how deeply it invades different layers of the stomach and whether it has spread to nearby organs, lymph nodes or other parts of the body, and on the patient’s general health.

Surgery

Surgery is the most common treatment for stomach cancer. Surgery can be used in any stage of the disease. Depending on the extent of cancer spread, recommended surgeries may include:

Partial (Subtotal) Gastrectomy – Part of the stomach is removed. Additional tissues or parts of organs such as the liver, pancreas, small intestine or spleen may also be removed together with the stomach if the tumor has invaded them.

Total Gastrectomy – The entire stomach is removed, along with the lower part of the esophagus, part of the small intestine (duodenum), and the surrounding lymph nodes. The remaining esophagus will be connected to the small intestine to allow the patient to eat.

Chemotherapy

Chemotherapy can be used to treat gastric cancer, either by itself or in combination with surgery and/or radiation therapy. It may be given before surgery (neoadjuvant therapy) to shrink the tumor size, or it may be given after surgery (adjuvant therapy) to help destroy any remaining cancer cells.

Drugs commonly used to treat stomach cancer are 5-Fluorouracil, Irinotecan, Cisplatin, epirubicin and Docetaxel. Most are given intravenously so they go to all parts of the body. A combination of these medications may be used. Chemotherapy may help control symptoms related to cancer and to delay cancer recurrence or spread.

Radiation Therapy

High-energy radiation is directed at the area of the tumor to destroy cancer cells or prevent their growth. Radiation therapy is commonly used in combination with chemotherapy to increase the effects of both.

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